Healthcare Provider Details

I. General information

NPI: 1639953565
Provider Name (Legal Business Name): ANGELA MICHELLE WOODFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 WILSON AVE
LOUISVILLE KY
40211-1969
US

IV. Provider business mailing address

3015 WILSON AVE
LOUISVILLE KY
40211-1969
US

V. Phone/Fax

Practice location:
  • Phone: 502-774-4401
  • Fax:
Mailing address:
  • Phone: 502-774-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1099305
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4016629
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4016629
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: